Tissue resecting instruments

ABSTRACT

A tissue resecting instrument includes a housing, a shaft extending distally from the housing and rotatable relative to the housing, and a tissue cutting extending distally from the shaft. The tissue cutter provides for both radial and distal resection of tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. Provisional Patent Appl. No. 62/970,519, filed Feb. 5, 2020, the entire content of which is incorporated herein by reference.

FIELD

The present technology relates generally to the field of tissue resection. In particular, the present technology relates to a tissue cutter of a tissue resecting instrument.

BACKGROUND

Tissue resection may be performed endoscopically within an organ, such as a uterus, by inserting an endoscope into the uterus and passing a tissue resecting instrument through the endoscope and into the uterus. Tissue resecting instruments include electrosurgical instruments using, for example, high-frequency electrical current, and/or mechanical surgical instruments using, for example, a cutting blade, to remove tissue.

SUMMARY

Techniques of this disclosure generally relate to a tissue resecting instrument including a tissue cutter for effectively resecting soft and dense tissue, and evacuating the resected tissue through the tissue resecting instrument.

In one aspect, the disclosure provides a tissue resecting instrument including a housing, a shaft, and a tissue cutter. The shaft extends distally from the housing and is rotatable relative to the housing, and the tissue cutter extends distally from the shaft. The tissue cutter includes and outer shroud and an inner cutting member. The outer shroud includes a cylindrical body having a proximal portion and distal portion terminating at a distal end. The cylindrical body defines a window therein that extends through the distal portion and the distal end. The window has a half cylinder shape such that the distal portion is a half cylinder with half of the distal portion, including half of the distal end, being open. The inner cutting member is disposed within the outer shroud.

The inner cutting member may be fixedly engaged to the shaft such that rotation of the shaft rotates the inner cutting member relative to the outer shroud.

The inner cutting member may include a shank portion disposed within the proximal portion of the outer shroud and a cutting portion disposed within the distal portion of the outer shroud. The cutting portion may include a channel defined in an outer surface thereof that is in open communication with a cavity defined in the outer shroud to define a space between the inner cutting member and the outer shroud. The space defined between the inner cutting member and the outer shroud may be in open communication with a lumen of the shaft. The shank portion may have a diameter that is smaller than a diameter of the cutting portion. The channel may be helical and wind continuously around an entire length of the cutting portion of the inner cutting member.

The tissue resecting instrument may include a fluid outflow tube in open communication with the lumen of the shaft.

The housing may include a drive mechanism disposed therein, the drive mechanism operably coupled to the shaft to drive rotation of the shaft relative to the housing.

In another aspect, the disclosure provides a tissue resecting instrument including a housing, a shaft, and a tissue cutter. The shaft extends distally from the housing and is rotatable relative to the housing. The shaft defines a lumen therethrough. The tissue cutter extends distally from the shaft and is rotatable with the shaft. The tissue cutter defines an opening through an outer surface thereof that is in open communication with the lumen of the shaft. The tissue cutter includes cutting edges disposed within the opening such that the outer surface is free of cutting edges.

The opening and/or the cutting edges may be helically wound around a cylindrical body of the tissue cutter.

The tissue resecting instrument may include a fluid outflow tube in open communication with the lumen of the shaft. The tissue resecting instrument may include a suction source operably coupled to the fluid outflow tube.

The housing may include a drive mechanism disposed therein, the drive mechanism operably coupled to the shaft to drive rotation of the shaft relative to the housing.

The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a tissue resecting system in accordance with an aspect of the disclosure;

FIG. 2 is an exploded, perspective view of a tissue resecting instrument and an outer sheath of the tissue resecting system of FIG. 1 ;

FIG. 3 is a perspective view of a tissue cutter of the tissue resecting instrument of FIG. 2 ;

FIG. 4 is a side view of a distal end portion of the tissue resecting system of FIG. 1 ;

FIG. 5 is a cross-sectional view of a tissue cutter of the tissue resecting system of FIG. 1 , taken along section line 5-5 of FIG. 4 ; and

FIG. 6 is a side view of a distal end portion of the tissue resecting system of FIG. 1 , including a tissue cutter in accordance with another aspect of the disclosure.

DETAILED DESCRIPTION

Embodiments of the disclosure are described hereinbelow with reference to the accompanying drawings; however, it is to be understood that the disclosed embodiments are merely exemplary of the disclosure and may be embodied in various forms. Well-known functions or constructions are not described in detail to avoid obscuring the disclosure in unnecessary detail. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the disclosure in virtually any appropriately detailed structure.

Like reference numerals may refer to similar or identical elements throughout the description of the figures. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning of a surgical instrument, the term “proximal” refers to a portion (e.g., an end) of the apparatus which is closer to the user and the term “distal” refers to a portion of the apparatus which is farther away from the user.

Referring to FIGS. 1 and 2 , a tissue resecting system 10 in accordance with the disclosure includes a tissue resecting instrument 100, an outer assembly 200 configured to removably couple to the tissue resecting instrument 100 (although, in embodiments, the outer assembly 200 may be integral with the tissue resecting instrument 100), a fluid pump 300 including a fluid supply reservoir 310 associated therewith, and a suction source 400 including a fluid collecting reservoir 410 associated therewith. The tissue resecting system 10 may be used in conjunction with a suitable endoscope (not shown) or may be used independently thereof. As detailed below, the tissue resecting system 10 is configured to facilitate the resection of tissue from within an internal body cavity or organ, e.g., a uterus, while enabling fluid inflow and fluid outflow to maintain proper distension of the uterus during the tissue resection procedure, flush tissue and other debris from within the uterus, and maintain a visible working space.

The tissue resecting instrument 100 generally includes a housing 110, an outer sheath connector 120, a shaft 130, a tissue cutter or shaver 140, a drive mechanism 150, and a fluid outflow tube 160. The housing 110 defines a body portion 112 and a distal nose portion 114. The outer sheath connector 120 is disposed on the distal nose portion 114 of the housing 110 and includes a collar 122 having a plurality of engagement features, e.g., radially-spaced male bayonet connectors 124, extending radially outwardly from the collar 122. The outer sheath connector 120 is configured to facilitate releasable engagement of the outer assembly 200 with the tissue resecting instrument 10. The fluid outflow tube 160 communicates with the interior of the housing 110 and/or the interior of the shaft 130 to enable the withdrawal, e.g., via suction, of fluid, tissue, and other debris from within the housing 110 and/or the shaft 130. The fluid outflow tube 160 is operably coupled to the suction source 400 to enable suction therethrough and for depositing the suctioned fluid, tissue, and other debris into the fluid collecting reservoir 410. The fluid outflow tube 160 may further include a valve 170 associated therewith for regulating the outflow of fluid from the housing 110 and/or the shaft 130.

The shaft 130 of tissue resecting instrument 100 defines a lumen (not explicitly shown) therethrough, and includes a proximal end portion 132 and a distal end portion 134. The shaft 130 is rotatably coupled to the housing 110 to enable rotation of the shaft 130 relative to the housing 110 about a longitudinal axis of the shaft 130. The proximal end portion 132 of the shaft 130 is disposed within the housing 110. The shaft 130 extends distally from the housing 110 through the outer sheath connector 120 to the distal end portion 134 of the shaft 130. The tissue cutter 140, described in greater detail below, is fixed relative to and extends distally from the distal end portion 134 of the shaft 130. The drive mechanism 150 is operably supported within the body portion 112 of the housing 110 and operably coupled to the proximal end portion 132 of the shaft 130. The drive mechanism 150 is configured to drive rotation of the shaft 130 relative to the housing 110, thus rotating the tissue cutter 140 relative to the housing 110 to resect tissue.

Continuing with FIGS. 1 and 2 , the outer assembly 200 includes a proximal hub 210, an outer sheath 220, a fluid inflow tube 230, and a valve 240. The proximal hub 210 is configured for positioning about the collar 122 of the outer sheath connector 120 of the tissue resecting instrument 100 and includes suitable engagement features, e.g., female bayonet connectors (not shown), to enable releasable engagement of the proximal hub 210 about the outer sheath connector 120 and, thus, releasable engagement of the outer assembly 200 about the tissue resecting instrument 100. The outer sheath 220 is fixed relative to and extends distally from the proximal hub 210. Upon engagement of the outer assembly 200 about the tissue resecting instrument 100, the outer sheath 220 of the outer assembly 200 is disposed about the shaft 130 of the tissue resecting instrument 100 so as to define an annular channel 222 between the shaft 130 and the outer sheath 220. The fluid inflow tube 230 of the outer assembly 200 is operably and, in some embodiments, releasably, coupled to the proximal hub 210 with the valve 240 disposed therebetween to enable fluid to be pumped from the fluid supply reservoir 310 into the proximal hub 210 and through the annular channel 222 by way of the fluid pump 300.

With additional reference to FIGS. 3-5 , the tissue cutter 140 of the tissue resection instrument 100 includes an outer shroud or sleeve 140 a, an inner cutting member 140 b disposed within the outer shroud 140 a, and a drive connector 140 c extending proximally from the inner cutting member 140. The outer shroud 140 a includes a cylindrical body 141 have a proximal portion 141 a terminating at a proximal end 141 b and a distal portion 141 c terminating at a distal end 141 d. The cylindrical body 141 defines a cavity 143 therethrough in which the inner cutting member 140 b is positioned. The proximal portion 141 a of the cylindrical body 141 of the outer shroud 140 a is a full cylinder (e.g., has a continuous cylindrical wall) that is open at the proximal end 141 b, and the distal portion 141 c of the cylindrical body 141 is a half cylinder defining a window 145 therein that extends to the distal end 141 d. The window 145 has a half cylinder shape such that half of the distal portion 141 c, including half of the distal end 141 d, is open, and the inner cutting member 140 b is exposed through the window 145.

The inner cutting member 140 b includes a shank portion 142 a and a cutting portion 142 b. The shank portion 142 a is disposed within the proximal portion 141 a of the outer shroud 140 a, and the cutting portion 142 b is disposed within the distal portion 141 c of the outer shroud 140 a. The cutting portion 142 b includes a channel or groove 144 defined in an outer surface 146 thereof that is helical in shape and winds continuous around the length of the cutting portion 142 b (e.g., from the shank portion 142 a to a tip of the cutting portion 142 b). The channel 144 is in open communication with the cavity 143 of the outer shroud 140 a, and the shank portion 142 a has a diameter “D1” that is smaller than a diameter “D2” of the cutting portion 142 b creating a space between the outer shroud 140 a and the inner cutting member 140 b, thereby providing a flow path into the window 145 of the outer shroud 140 a, between the outer shroud 140 a and the inner cutting member 140 b, and into the lumen of the shaft 130. Alternatively, the flow path may be created by hollowing out the inner cutting member 140 b to allow fluid to flow therethrough. Cutting edges 148 surround the channel 144 and extend continuously around the length of the cutting portion 142 b.

The drive connector 140 c extends proximally from the shank portion 142 a of the inner cutting member 140 b and extends proximally beyond the proximal end 141 b of the outer shroud 140 a.

The proximal end 141 b of the outer shroud 140 a abuts the shaft 130 in a fluid tight manner such that the drive connector 140 c extends into the shaft 130. The drive connector 140 c is connected to the drive mechanism 150 (FIG. 2 ) and couples the inner cutting member 140 b to the shaft 130 such that the inner cutting member 140 b is rotatable with the shaft 130 relative to the outer shroud 140 a.

In use, inflow fluid is pumped into the surgical site through the annular channel 222 defined between the shaft 130 and the outer sheath 220, as indicated by arrows “A,” and outflow fluid is suctioned, along with tissue and other debris, through the window 145 of the outer shroud 140 a, into the channel 144 of the inner cutting member 140 b, past the shank portion 142 a, and through the shaft 130, as indicated by arrows “B.” The suctioning of tissue into the channel 144, in combination with the rotation imparted to the tissue cutter 140 by drive mechanism 150 (FIG. 2 ), enables the resection of tissue using the cutting edges 148 and the suctioning of the resected tissue proximally through shaft 130. The configuration of the window 145 of the outer shroud 140 a and the cutting edges 148 of the inner cutting member 140 b provides for both radial and distal resection of tissue.

Referring now to FIG. 6 , another configuration of the distal end portion of the tissue resecting system 10 (FIG. 1 ) is provided wherein the shaft 130 includes a tissue cutter 540 extending distally therefrom. The tissue cutter 540 includes a cylindrical body 542 defining an opening 544 through an outer surface 546 thereof providing access to the lumen of the shaft 130. The cylindrical body 542 further includes cutting edges 548 disposed within the opening 544 such that the outer surface 546 is free of cutting edges. The opening 544 and the cutting edges 548 are helically wound around the tissue cutter 540, but other configurations are envisioned in which the cutting edges 548 are disposed radially inwardly of the outer surface 546 of the cylindrical body 542.

In use, inflow fluid is pumped into the surgical site through annular channel 222, as indicated by arrows “A” and outflow fluid is suctioned, along with tissue and other debris, into the opening 544 of the tissue cutter 540 and through the shaft 130, as indicated by arrows “B.” The suctioning of tissue into the opening 544, in combination with the rotation imparted to the tissue cutter 540 by the drive mechanism 150 (FIG. 2 ), enables the resection of tissue using the cutting edges 548, and the suctioning of the resected tissue proximally through shaft 130.

While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. It is to be understood, therefore, that the disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, the elements and features shown and described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the disclosure, and that such modifications and variation are also included within the scope of the disclosure. Therefore, the above description should not be construed as limiting, but merely as exemplifications of embodiments of the disclosure. Thus the scope of the embodiments should be determined by the appended claims and their legal equivalents, rather than by the examples given. 

What is claimed is:
 1. A tissue resecting instrument, comprising: a housing; a shaft extending distally from the housing and being rotatable relative to the housing, the shaft including a lumen defined through the shaft from a proximal end of the shaft to a distal end of the shaft; and a tissue cutter extending distally from the distal end of the shaft, the tissue cutter including: an outer shroud including a cylindrical body having a proximal portion and distal portion terminating at a distal end, the proximal portion of the cylindrical body abutting the distal end of the shaft, the cylindrical body defining a window that extends through the distal portion and the distal end, the window having a half cylinder shape such that the distal portion is a half cylinder with half of the distal portion, including half of the distal end, being open; and an inner cutting member disposed within the outer shroud and fixedly engaged to the shaft such that rotation of the shaft rotates the inner cutting member relative to the outer shroud, the tissue cutter having a space defined between the inner cutting member and the outer shroud that is in open communication with the lumen of the shaft to define a flow path into the window of the outer shroud, between the inner cutting member and the outer shroud, and through the lumen of the shaft.
 2. The tissue resecting instrument according to claim 1, wherein the inner cutting member includes a shank portion disposed within the proximal portion of the outer shroud and a cutting portion disposed within the distal portion of the outer shroud.
 3. The tissue resecting instrument according to claim 2, wherein the cutting portion includes a channel defined in an outer surface of the cutting portion that is in open communication with a cavity defined in the outer shroud, the channel and the cavity defining the space between the inner cutting member and the outer shroud.
 4. The tissue resecting instrument according to claim 3, wherein the shank portion has a diameter that is smaller than a diameter of the cutting portion.
 5. The tissue resecting instrument according to claim 3, wherein the channel is helical and winds continuously around an entire length of the cutting portion of the inner cutting member.
 6. The tissue resecting instrument according to claim 1, further comprising a fluid outflow tube in open communication with the lumen of the shaft.
 7. The tissue resecting instrument according to claim 1, wherein the housing includes a drive mechanism disposed in the housing, the drive mechanism operably coupled to the shaft to drive rotation of the shaft relative to the housing.
 8. The tissue resecting instrument according to claim 7, wherein the inner cutting member includes a drive connector extending proximally beyond the outer shroud and into the lumen of the shaft, the drive connector operably coupled to the drive mechanism.
 9. The tissue resecting instrument according to claim 1, further comprising an outer sheath connector, the outer sheath connector configured to releasably engage an outer assembly including an outer sheath that extends over the shaft and defines an annular channel between the shaft and the outer sheath.
 10. The tissue resecting instrument according to claim 9, wherein the outer sheath connector is disposed on a distal nose portion of the housing and includes at least one engagement feature extending outwardly from the housing.
 11. The tissue resecting instrument according to claim 9, wherein the outer assembly includes a fluid inflow tube in communication with the annular channel.
 12. The tissue resecting instrument according to claim 1, wherein the inner cutting member includes cutting edges, and the outer shroud is free of cutting edges.
 13. A tissue resecting instrument, comprising: a housing; a shaft extending distally from the housing and being rotatable relative to the housing, the shaft including a lumen defined through the shaft from a proximal end of the shaft to a distal end of the shaft; and a tissue cutter extending distally from the distal end of the shaft and being rotatable with the shaft, the tissue cutter including a cylindrical body having an opening defined through an outer surface of the cylindrical body that is in open communication with the lumen of the shaft, the cylindrical body including cutting edges disposed within the opening such that the outer surface is free of cutting edges, the cylindrical body defining a distal end of the tissue resecting instrument.
 14. The tissue resecting instrument according to claim 13, wherein the opening is helically wound around the cylindrical body of the tissue cutter.
 15. The tissue resecting instrument according to claim 14, wherein the cutting edges are helically wound around the cylindrical body of the tissue cutter.
 16. The tissue resecting instrument according to claim 13, further comprising a fluid outflow tube in open communication with the lumen of the shaft.
 17. The tissue resecting instrument according to claim 16, further comprising a suction source operably coupled to the fluid outflow tube.
 18. The tissue resecting instrument according to claim 13, further including a drive mechanism disposed in the housing, the drive mechanism operably coupled to the shaft to drive rotation of the shaft relative to the housing.
 19. The tissue resecting instrument according to claim 13, further comprising an outer sheath connector, the outer sheath connector configured to releasably engage an outer assembly including an outer sheath that extends over the shaft and defines an annular channel between the shaft and the outer sheath.
 20. The tissue resecting instrument according to claim 13, wherein the tissue cutter includes a channel defined in an outer surface of the cylindrical body, and the opening and the cutting edges are defined in the channel. 